Purposeful partnerships and practices: an
international education collaboration in global
health
Wintrup, J., Nascimento, J., D’Aeth, A., Phillips, L., Wheeler, L., Laosebikan,
P., Adams, J. and Truman, J.
2
Contents
Section Page
Executive summary 4
Background to research 4
Themes in literature 4
Methodology 5
Discussion of findings 5
Conclusions and implications 5
Introduction 7
Study rationale and aims 8
Occupational therapy: part of a global workforce 8
The broader context 10
Global health goals and education 10
Notions of intercultural capability 10
Methodology 12
Students as co-researchers 12
Constraints and limitations 12
Developing the research question 12
Study design 13
Ethical approval 13
Methods 13
Recruitment of research participants 13
Data collection 13
Data analysis 14
Discussion of findings 15
Meaningful relationships, purposeful partnerships 15
Cultural diversity, professional identity and a global community 20
Expectations, experiences and achievements 23
Reflecting, speculating and imagining: parallel perspectives. 29
One student’s experience of staying at home 31
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Conclusions and implications 36
Fostering partnership working through pedagogic approaches:
implications for teaching and learning 36
On working together 41
References 42
Acknowledgements 46
Appendix 1: Ethical issues and approval processes 47
Ethical issues and approval processes 47
Data protection and anonymity 47
Appendix 2: Example of interview schedule 48
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Executive summary
Students studying in UK universities can expect an international and cosmopolitan education,
learning with and from people of all nationalities, gaining new perspectives and beginning to see
themselves as citizens of the world. International travel and periods of relocation are already part
of higher education for some, yet data indicates that certain groups rarely study abroad. Despite
past trends, health students’ use of Erasmus exchanges has been found to be decreasing in recent
years. While the complex interplay between personal, academic and career issues means each
student’s decision is unique, learning from successful approaches to broader forms of participation
is important given how much is known about the personal benefits and mutual rewards of exchange
programmes.
A collaborative project between Southampton and Lund Universities offers an alternative to the
traditional individual exchange programme, providing short, intensive ‘visits’ to each other’s
countries involving all final year students. This report offers findings from Higher Education
Academy (HEA)-funded research into the collaboration, carried out with student researchers and
based on a participative, co-researcher methodology. Six pedagogic approaches that promote
partnership working are discussed and incorporated into a ‘circles of partnership’ exercise for
those interested in developing collaborative exchange schemes.
Background to research
To make an international education a reality for Occupational Therapy students, who spend
considerable periods of time in local health and care organisations learning through practice, an
existing research relationship with Lund University was explored for its educational potential. Now
entering its fourth year, the collaborative model is based on short intensive visits for all final year
students studying Occupational Therapy at Lund and Southampton universities. Funding has been
variously sourced, and sustainability remains a goal, making research timely and important.
Competitive tendering was successful through the HEA ‘Students as partners’ strand of work,
enabling a year-long investigation to take place.
Themes in literature
The development of a more globally orientated workforce has long been a goal of the World
Health Organisation (WHO). Professionals with a pluralistic worldview and intercultural skill and
competence are key to developing a global health workforce. Yet ways of incorporating this goal
into nationally and regionally commissioned higher education (HE) programmes remain elusive:
classroom strategies alone have been found to be problematic, while critics of ‘gap year’ or shorter
volunteer schemes consider them to do more harm than good. Research has found that even well
organised exchange schemes only marginally affect students’ sense of intercultural capability. The
broader demographic of students reflected in health programmes means inclusive, sustainable,
international education needs to be more widely available if new approaches, not dependent solely
on individual travel and relocation, are to be offered. Little research exists into international
collaborations from the perspectives of so-called ‘non-traditional’ students or by student
researchers.
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Methodology
The research question asked whether and how the international partnership influenced students’
knowledge, understanding and sense of identity as global healthcare citizens, and whether they
considered intercultural capabilities to be developed through their professional education.
An interview-based study elicited rich qualitative data from which themes were developed. An
online survey evaluation was developed from the refined interview schedule. Involvement by
student co-researchers in all aspects of methodology characterised the research team’s work,
including study design, methods, interview schedule development, all stages of ethical approval
gained from the Faculty of Health Sciences in November 2014, and finally authorship and
dissemination of the commissioned report.
Discussion of findings
Four themes were developed that explored the development of meaningful relationships between
students; the development of a professional identity as part of a global community; expectations,
trepidation and reflections on achievements; and beginning to speculate on how others experienced
the world. Each theme served to complicate and enrich notions of students working in multiple
partnerships and as members of communities, and to challenge concepts of students as self-
interested agents or consumers. Interviewees’ detailed accounts explore and offer insights into the
way their knowledge deepened and confidence and understanding grew, while they started to look
afresh at their profession, its global nature and the need to become agents of social change.
Honesty and openness in interviews showed how social and personal learning took place and was,
for some, transformative.
The pedagogic approaches that served to promote generosity and mutuality emerged in
participants’ detailed descriptions and accounts. Findings introduced the potential of working on
shared concerns as a means to transcend local and national healthcare systems and to discover new
allegiances and alternative futures.
Conclusions and implications
Six pedagogic approaches with established roots in education theory and research are compared
with findings, each being in some way or other pivotal to the establishment and sustenance of
partnership working. Each is presented and discussed in terms of their broader application, and an
exercise we call ‘circles of partnership’ is suggested as part of developing a holistic approach to
inter/national collaborative ventures.
Working on ‘real’ projects and shared concerns
Students described the short intensive visits as remarkable in their effectiveness in forging
productive project work groups, able to carry out research, overcome language differences, and
present to peers after only five days. In working hard both practically and intellectually, learning by
doing, and developing more reflexive approaches, they reflected the theoretical work of Beckett
(2009) and Billett (2008).
Informal learning
The importance to participants of time spent simply ‘being’, whether together in mixed project
groups, or as friendship groups, or travelling and socialising, the importance to them of informal
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time cannot be over-estimated. We conclude that, as Usher (2010) and others have asserted, the
potential of informal learning, not being assessed or overviewed, is undervalued in education more
generally.
High expectations, high support
The stimulation of learning independently, with sometimes ambiguous or seemingly abstract briefs,
was deeply rewarding. ‘High level’ support meant final year students were required to immerse in
topics and were able to call upon ‘experts’ in informed ways. Balancing high expectations with high
support – of the kind students find supportive – is developed from Kift, Nelson and Clarke’s (2010)
research.
Communities of practice and circles of partnership
Participants spoke of ‘feeling’ part of a community that went beyond education and practice
contacts, and of being involved in networks developed through social media. Many shared and
contributed through forms of reportage, seeing their work circulated widely. The ‘joint enterprise’
of Wenger’s (1998) concept of communities of practice emerged in descriptions of relationships
forged around common purposes, and led us to develop a ‘circles of partnership’ exercise to
further involve students in international collaborations.
Embedding principles of care, hospitality and reciprocity in partnerships
Mann’s (2008) work provided a starting point for understanding the many kinds of inclusivity – and
exclusivity – described by participants, and engendered by travel, visits, new relationships, and new
‘selves’. Ways to involve students unable to travel, or who choose not to do so for a variety of
reasons, and the wider duties of institutions and technologists, are discussed.
Students as producers of high quality healthcare
Final year students showed themselves to be fully aware of their contribution to practice, to education and to a global healthcare community. New insights meant healthcare decisions were
critiqued in societal and political terms rather than through the lenses of pragmatism, expediency
and necessity. We suggest Neary’s (2013) concept of student as producer opens the door to much
more explicit constructions of students as producers and as partners: with people using services,
with practitioners and with their academic colleagues.
The report concludes with reflections on the potential for partnership working that is based on a
questioning, critical and pluralist approach to education more generally, and which is recognisable
within curricula and across the institutions of higher education.
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Introduction
Students entering universities in the United Kingdom (UK) are promised an international,
cosmopolitan education. Whatever their course of study, they can expect to learn with people
from different parts of the world, to question and evaluate belief systems, to gain new perspectives,
and to begin to see themselves as citizens of the world, sharing concerns that transcend
geographical boundaries. This report considers how such ideas can be ignited and explored in
partnership with students, through the curriculum, and how they have the potential to influence and
challenge the ‘culturally specific constructions’ of knowledge that come to define what is taught
(Grant 2013, p. 12).
We present research into a collaborative project that has exploration at its heart, as students from
two universities visit each other’s countries, share learning formally and informally, and explore the
ideas and values underpinning their national health and care systems. It is redolent of the kind of
student mobility that Riordon regards as a ‘global mindset’ (Joint steering group on UK outward
student mobility 2012), central to the development of a sense of oneself as a person in the world,
that connects to global health allegiances and interests that go beyond narrow specialisms or
national interests. The project that started with a conversation between academics was realised
with and by students, and it is the students’ words that reflect higher education’s
internationalisation agenda in very human and engaging ways.
Students’ descriptions reveal how the espoused curriculum becomes lived and experienced;
through intellectual involvement and exposure to new people, places and ideas, to study and work
routines, through visits and travel, the use of social media and virtual forms of communication and
in friendships and communities of practice. As with all learning, not everything goes smoothly and
tensions become apparent through the research. Being part of something new and exciting raises
questions about those who are unable, or choose not to be involved, or offer different
contributions. Confusion around group membership, belonging and identity proves to be a catalyst
for deeper reflection. How students and academics work together in different places and less
formal settings becomes interesting to think about. Beginning to question assumptions and preconceptions is both unsettling and liberating. Freedom to engage in social media and reportage
produces authentic, contemporaneous accounts and images, which lead to important discussions of
representation, use and ownership. Questions about how we learn through partnerships, with
whom we choose to partner, and how such decisions are made, emerge as important areas for
future discussion. Running throughout is the nascent sense of challenge to the established order of
things – in age-old fashion, going away reveals the strangeness of home and makes taken-for-
granted ways of doing things objects of interest.
Findings chime with discourses around internationalisation as a broader project, and with critiques
of extracurricular ‘voluntourism’ activities (Tourism Concern 2014). Grant (2012), in calling for a
more international outlook, brings attention to UK and Euro-centric attitudes, and wonders
whether fear and suspicion of the unknown on the part of academics is holding back a more
wholehearted embrace of new partnerships. Emerging critiques of the ways engagement in learning
focuses on ‘participation’ (MacFarlane 2015) offer more nuanced appreciations of less well-explored
ways in which students might learn from international partnerships – without traveling. Inevitably,
the inequities between students are being recognised and surfaced in work by King, Findlay and
Ahrens (2010) and more recently by Bridger (2015), all of whom question how to ‘widen
participation’ in international exchange schemes for students in less advantaged groups.
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So notions of partnership, while ubiquitous, are far from straightforward. This report describes
research into a collaboration designed with inclusivity and partnership in mind. Students of a
regionally commissioned, regulated health programme at the University of Southampton are part of
an international education partnership, which is becoming embedded into their curriculum. Funded
by the Higher Education Academy (HEA) through its ‘Students as Partners’ strand, the research is
part of a broader programme of activity. The aims of the HEA include being able “to support
organisations to achieve strategic ambitions to enhance teaching and learning” and “to improve
teaching and the student experience” (HEA website). The research was therefore required to:
increase understanding of pedagogical approaches that foster partnership;
provide evidence of the impact these pedagogies have on student learning;
offer clear implications for teaching and learning practice.
These overarching objectives informed both design and methodology of the study, and are returned
to in the conclusion.
Study rationale and aims
The Occupational Therapy programme team at the University of Southampton is three years into
the development of an ambitious, whole-cohort, staff and student exchange programme with their
counterparts at Lund University, Sweden. The academics wished to inspire and motivate their
students and to introduce them, as future global health citizens, to the international dimensions of
their profession. Their unique model offers a template to others interested in such collaborations,
yet other than immediate and unanimously positive student evaluations, academics had little robust
understanding of its deeper educational value to students of the type that might be discovered
through more fine-grained and critical feedback. Still less was known about the impact of the wider project, for example, on students who did not take part in exchange visits, or in terms of the
potential for curriculum innovation or even Faculty and University strategy.
Deeper inquiry was felt to be important too, if evidence was to be generated and shared with
others beyond the health professions; for critique, adaptation and application. The opportunity to
learn with and from students was presented by the HEA ‘Students as Partners’ strand of research.
Using the idea of partnership as a lens, we sought rich, in-depth descriptions and perspectives, and
of shared, communal and personal forms of development. Interviews generated detailed accounts of
whether and how the collaboration’s espoused values and activities were enacted – by others and
in plans and events – and explored how students experienced in their everyday activities a sense of
partnership working. Lecturers and practitioners who instigated and participated in the project
were generous and open with information and impressions, providing important contextual
knowledge and data. Students employed as co-researchers enriched and in parts transformed the
study design, interview schedule development, data collection and analysis, and ultimately co-
authored this report.
Findings, discussions and conclusions are intended to support future students and academics in
developing international collaborations, and in better understanding how different pedagogic
approaches that promote partnership working might be evidenced and applied in different
disciplines and broader contexts.
Occupational therapy: part of a global workforce
Occupational Therapy is interested in working with people to improve their wellbeing and health,
through environmental and societal change as well as embodied means, and is rooted in a
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philosophy of social justice (Kronenburg, Pollard and Sakellariou 2010). This is borne out in its
history of women leaders who frequently relocated to develop schools, hospitals and community
projects in all parts of the world (Mendez and Harris 1992). A warm welcome was extended to
occupational therapists travelling to and working in Britain. Yates (1996) used a prestigious lecture
to compare the diversity of the profession in the past, with more recent trends. The World
Federation of Occupational Therapy (WFOT) was established in 1951 and continues to thrive.
While global ambitions have to be balanced with a national and regional workforce needs, the need
for an intercultural, skilled and capable workforce remains pressing given the health needs and
variable outcomes of the UK’s diverse populace (Parliamentary Office of Science and Technology
2007).
At Southampton, alongside many years of undergraduate education, a track record of productive
research with peers in Lund University led to conversations among educators and researchers.
They discovered an interest in a more educationally focussed collaboration and, since 2012,
students have been invited to take part in short intensive visits to each other’s countries to carry
out clinically focussed, evidence-based activities. Feedback, in the form of anonymous
questionnaires, was almost unanimously positive and included descriptions of transformative
learning. For some students, it was their first time abroad. Others needed to make arrangements
for childcare and other work and care responsibilities, reflecting a demographic typical of health
professions’ students and found in a longitudinal study by Watson et al. (2007).
Positive evaluations, while rewarding, raised questions for the academics: they wondered who they
were not hearing from through the questionnaires, and whether students were reluctant to offer
more critical accounts given the general air of excitement around the project, and an undeniable
sense of gratitude towards the academics who had worked hard on its organisation and funding. As
a programme team, they were curious, too, to discover the specific aspects of the collaboration
that contributed to learning, and wondered whether this kind of ‘fieldwork’ – in contrast to
assessed clinical practice – had a place in the curriculum.
The sustainability of the project and financial alternatives for the future led academics, prior to the
research being commissioned, to be actively questioning how to capture and build on this unique experience, and how to elicit deeper and more critical feedback on which to reflect. Students with
new and different perspectives on the project were equally motivated to share their learning, to
contribute to future students’ experiences and several were prepared to invest time as co-
researchers.
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The broader context
The way the collaboration sought to improve occupational therapy practice, through its
development of individuals with more informed and broader worldviews, accords closely with the
Global Health Workforce Alliance (GHWA) perspective on the development of an international
health workforce. Questions raised by GHWA revolve around how health students’ education can
more routinely incorporate principles of collaboration, holism and interdisciplinarity, in the
classroom, workplace and beyond (GHWA 2013). Health services face considerable pressures
across the world and share a need for skilful, knowledgeable workers able to utilise evidence,
exploit technological advances, and above all, think pluralistically. In the words of the GHWA,
“health services are only as effective as the persons responsible for delivering them” (2014, p. vi).
Global health goals and education
Throughout their careers, health professionals, in addition to their caring work, need to influence
events and decisions: ethically, strategically and politically (Kronenberg et al. 2010). Their
undergraduate education is the first opportunity to establish such standards and to educate with
these ambitions in mind. To this end Hocking (2014, p. 591) proposes a new standard for
occupational therapy education: “that all educational programmes state their commitment to
contribute to societal change”, reflecting the need for change agents and partners in society
identified by GHWA (2014).
Notions of intercultural capability
The hope of the Southampton–Lund collaboration to prepare occupational therapists for a new
kind of international and intercultural professionalism has to compete with the immediacy of
everyday clinical work, which is more immediately absorbing and emotionally stimulating than more
abstract, future orientated ideas (Beckett and Hager 2002). Educators, nonetheless, have the task of
introducing such divergent sets of interests in ways that are coherent and engaging to students.
Nigel Crisp finds one way to do so, describing the ‘global doctor’, in Willott et al. (2012):
All UK doctors, whether they choose to work in the developing world or as GPs in Britain, must have an
awareness of global issues. It improves their critical thinking, enables them to empathise more with their
patients and develops their knowledge of health systems, not least our own. The Global Doctor of the
future will understand how the wider world fits into their practice, whether at home or abroad. (Willott
et al. 2012, p. 2)
Knowledge has an important part to play in developing such understanding, yet moving beyond an
intellectual interest to relationships, understanding and practical, intercultural ability is clearly a goal
of GHWA (2013). Attempts to cultivate such ability and interest through ‘voluntourism’ – short
periods spent (typically) working with children in low income countries – are criticised as “doing
more harm than good”: taking paid work away from local people, creating unsustainable and short-
lived relationships with vulnerable children and others, and finally paying exorbitant amounts of
money to travel agencies which might be used to better ends (Tourism Concern 2014). Root and
Ngampornchai (2012) found that even well organised, international exchange programmes within
higher education are not certain to influence, at a deep level, students’ intercultural competence. In
health education, a competence-based approach has been critiqued and found wanting (Queensland
Health 2010, p. 13).
One answer to the limitations of a competence approach is a more holistic and ‘internationalised’
curriculum (Leask 2009). However, Scudamore (2013) considers that neither renewed content nor
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a focus on intra-classroom strategies necessarily serve to challenge dominant pedagogic approaches.
If anything, her findings suggest traditional classroom-based education can serve to reinforce forms
of learning and assessment based on language skill, rather than on thinking ability.
So we might ask, where do these findings leave educators wishing to develop such broader global
interests and relational abilities in their students? Refuting the notion of individual attributes or
competences offers a more fruitful avenue; Nussbaum (2007) describes capability as a
contextualised, dynamic between person and environment. Places, goals, structures, tasks and
processes become the means through which skills, values and socio-political awareness might be
realised and performed. Viewed this way, intercultural capability requires socially and ethnically
diverse student cohorts (Nussbaum 2007), with time and opportunity to engage socially and
intellectually (Arkoudis and Tran 2010), in naturally occurring, informal and authentic ways
(Bamford 2008) if it is to be a feature of a higher education.
Together, the different perspectives from literature and educational practice influenced our
research – its design, methodology and data collection – which became in itself an opportunity to
take time to work together as a group of students and academics.
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Methodology
Students as co-researchers
Bearing in mind Fielding’s (2001, p. 123) description of students as “radical agents of change” and
his call for more emancipatory and participatory methods, we made a commitment to work as a
team of researchers with shared responsibilities. This required that we work with and around
students’ placements and assignment deadlines if their limited time was to be spent to best effect.
Students needed scope to dip in and out of the project without compunction.
Healey, Flint and Harrington’s (2014, p. 3) conceptual framework helped us to locate the research
as “co-researching and co-inquiring”, somewhere in the overlap between “subject based research”
(global health) and “scholarship of learning and teaching.” (How do students report and describe
their learning?) Its constructs helped clarify that student co-researchers were simultaneously
engaged in reflecting on their own experiences to develop the research design and methods, and
thinking in more general terms about how students are affected by their education. This required
intellectual work to move between personal, descriptive accounts and more abstract, speculative
discussions, during interviews and analysis.
The lead taken by our dedicated research assistant was pivotal: an Anthropology graduate between
Masters’ degree and PhD, her closeness to the students in age and interests meant she connected
with them in a number of important ways, discovered and reinforced through the visit to Lund.
Only when contracts were signed could the invitation be made to all third year Occupational
Therapy students to work with us as co-researchers. When six co-researchers were recruited and
employed as temporary workers, the original proposal was revised following their examination and
critique. The research tendering process several months earlier had required that the research
question, design and methods be described in detail, yet we found ourselves almost ‘beginning again’
as a new team with student co-researcher colleagues. The approaches they thought would best
answer the research question, their methodological preferences, and importantly, their insights,
skills and interests informed and ultimately improved the original proposal greatly.
Constraints and limitations
Perspectives of volunteer participants are in large part those of Southampton students who visited
Lund. Of the Southampton students who did not visit Lund, only one volunteered for and was able
to be interviewed, and none completed the online survey. Two Lund students also volunteered and
followed through with interviews. Several others volunteered but for various reasons were not able
to be interviewed within the timeframe, hence the decision to make an online survey available.
Developing the research question
While background information was available in project reports and feedback, it was students’
words that interested us. Both the process of learning and the things learned were of interest.
Notions of ‘partnership’ were implicit but not foregrounded.
The research question asked whether and how an international partnership in healthcare influenced
Occupational Therapy students’ knowledge, understanding and sense of identity as global healthcare
citizens, and whether they considered intercultural capabilities to be developed through their
professional education.
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Study design
Phase 1 included a mixture of face-to-face and Skype interviews with Southampton students,
conducted by six student co-researchers working in pairs, and supported and trained by the
research assistant.
Phase 2 included analysis of student interview data, early theme development and development of
interview schedules for further interviews with Lund students.
Phase 3 included further development and refinement of themes, followed by individual interviews
with students from Lund University. An anonymous online survey evaluation was developed using
adapted interview questions and emailed to the Southampton cohort.
Ethical approval
Ethical approval was sought for each phase in turn, to enable later phases to be refined in response
to themes emerging from interviews (see Appendix 1 for further information). This iterative
process served to maintain student involvement in developing the research as it progressed,
building in scope for responsiveness and flexibility.
Student co-researchers were supported by the research lead and research assistant, in basic
interview technique, confidentiality and legal issues, use of audio and management of data, consent
and release forms.
Methods
Individual, in-depth, semi-structured interviews offered scope for reflection and openness and were
something student co-researchers felt confident to undertake. See Appendix 2 for an example of
the interview schedule with additional ‘prompt’ questions and guidance. Subsequently the interview
schedule was adapted and new questions developed for other groups or individuals being
interviewed, such as the student who did not go on the exchange visit or those studying at Lund University. Volunteers were invited to make contact directly with student co-researchers and the
research assistant, who conducted the interviews.
In April 2015, during phase three, interview questions were abbreviated and formed into an online
survey seeking qualitative and quantitative responses, subsequently made available to the
programme team to trial and use in future years. This was designed to offer an opportunity to any
students who wished to contribute in a completely anonymous way to the research.
Recruitment of research participants
Volunteers were sought from Southampton’s 2014-15 HE Level 6 cohort of Occupational Therapy
students and from Lund University final year students. A £20 book token was given in recognition
and gratitude for the contribution, to all interviewees.
Data collection
Participants were considered ‘expert learners’; interview questions were active in tone, focusing on
critical description, views and perspectives, in the way Holstein and Gubrium (1995) describe.
Interviews were audio recorded and transcribed. Audio files were stored along with transcriptions
according to University policy and the Data Protection Act 1998.
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The research assistant took responsibility for overseeing recruitment, support, organisation and all
data protection issues in relation to participants. Raw interview data was fully anonymised at the
point of transcription.
Fourteen student volunteers were interviewed and 12 Southampton students completed and saved
the anonymous online evaluation (see table below for breakdown). A further 10 attempted the
survey but did not save responses, meaning none of their data could be used. Gender and age range
only were sought, and then only from interviewees: 13 were female, one was male, and ages ranged
from 21 years to over 35 years of age. Four of the six student co-researchers carried out 10
interviews and the research assistant carried out four. While rich qualitative data given in survey
responses influenced our interpretations and allowed for helpful cross-referencing, quotations in
this report are taken only from interview data. Explicit consent to reproduce words as quotations
was gained during recruitment and, in particular instances, again following analysis and
interpretation as a form of member checking.
Table 1: Interviewees and survey respondents
Interviewees
Southampton Did not visit Lund 1
Visited Lund only for 5 day exchange 10
Visited Lund for 5 day exchange and returned for extended 13-week
placement
1
Lund Participated only in hosting the 5 day
exchange visit in Lund
1
Participated in hosting the 5 day
exchange visit in Lund and
subsequently visited Southampton
for an extended twelve week visit
1
Total number of students interviewed 14
Survey respondents
Survey respondents: Southampton students who visited Lund 12
Total number of student contributors 26
Data analysis
Analysis followed Braun and Clarke’s (2006) six-stage analysis. Early interviews enabled potential
‘clusters’ of related ideas to be identified and developed, allowing an iterative process to take place
as further interviews were conducted over weeks and months. New perspectives and descriptions
emerged throughout the process of analysis.
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Discussion of findings
Four broad, interconnected themes emerged that enriched and deepened concepts from the
literature:
1. Meaningful relationships, purposeful partnerships
2. Cultural diversity, professional identity and a global community
3. Expectations, experiences and achievements
4. Reflecting, speculating and imagining – parallel perspectives
Students’ impressions tell us that, in the context of the Southampton–Lund exchange project, the
concept of partnership acquired multiple meanings, taking on different forms, and involving diverse
actors and relationships. The whole-cohort approach to the ‘visit’ made the project exciting in its
promise of an intense week working with fellow occupational therapy students in a different
country.
Depending on their small group activity in mixed Lund–Southampton groups (referred to from here
as ‘project work’), some of the students visited healthcare institutions and met individuals outside
the University of Lund. Asked about the project work, they were able to describe how these
experiences took place and how they influenced their learning. The establishment and development
of meaningful relationships before, during, and after the visit to Lund, played a crucial part in the
way partnership working took place between students, lecturers, and service users or members of
the public.
The act of physically travelling to Lund to meet another cohort of students studying the same
subject produced interesting encounters, conversations and events that invite the consideration of
issues of hospitality, similarity and difference, and cross- cultural understanding. We consider how
such experiences inform, and are informed by, collaborations based on more virtual or
geographically distant relationships.
Meaningful relationships, purposeful partnerships
Getting to know each other
Travelling together, working together, laughing together, struggling with work together, living
together. These were some of the expressions used by Southampton students to describe what
they considered to be some of the most memorable aspects of their experience of the visit to
Lund. Read in isolation, some of these things can be easily imagined to take place when a group of
students travels to a different country and shares accommodation for that period of time (fun, fun,
fun!). However, listening to each individual student’s impressions reveals that these are in no way
superficial events, and that they played a fundamental part not only in their personal enjoyment
(and development), but had an important influence on how their work took place during that week,
leaving them with valuable insights, lessons to apply in future experiences, a network of ‘like-
minded people’, and, in some cases, friends.
Describing their reasons for going on the visit, some students emphasized their wish to meet other
Occupational Therapy students, and to discover how the profession is taught and practised in a
different country. Others added that they wanted to get to know the Swedish students and maybe
find new friends. All of the students we interviewed found it relevant to meet and spend time with
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fellow students from another country, and many found that the experience contributed to a greater
connection with other students from their own cohort.
Describing how relationships developed as part of the visit to Lund, students emphasized two
aspects that, in their view, brought them closer as a cohort. On the one hand, they shared hostel
rooms in groups of six or eight and, as a student put it, “lived together” for a period of five days.
Regardless of the challenges, for some, this was a crucial opportunity to chat, to find out more
about each other, and to bond in casual, fun and unexpected ways. On the other hand, the
composition and organisation of the different project work groups, comprised of both
Southampton and Lund students, made students more aware of each other’s presence and common
origin, contributing to a sense of shared identity. This stimulated mutual support within the group
(for example, when faced with the inability to speak Swedish and communicate with members of
the public that they were supposed to interview as part of their project work).
The selection of groups by project work themes – rather than by existing friendship groups – also
meant that many Southampton students worked together for the first time in two years of being on
the same programme. Academics noticed how the visit transformed the usual dynamics of the
cohort, recalling how they returned as a more cohesive group, and how this contributed to a
greater sense of collegiality – not only among the students, but in their relationship with the
lecturers as well. Asked about how she looked back on partnership working with lecturers during
the week in Lund, one of the students replied that she found it “very beneficial”:
I think, we got to know them better, which just generally helps us if we want to go to them with any
questions, queries or concerns. It’s just nicer if you’re working more in partnership and you feel more as
a group rather than lecturer-student, so it took boundaries out of the relationship.
Getting to know Swedish peers
Travelling to Lund and working for five days with Swedish Occupational Therapy students was an
important way of developing meaningful relationships and engaging in immersive project work.
Asked if they felt as though they had worked in partnership with Swedish peers, students invariably replied “definitely!”, going on to describe the group effort that their projects required, and the
common energy that they had summoned. Most students agreed that the week spent in Lund was
extraordinary in its intensity: a short period of time, complex project work, a pressing deadline to
compose and present their projects, and a whole array of things they wanted to find out about each
other and about each other’s countries, their health systems, socio-cultural practices and
Occupational Therapy practice and education.
Some students affirmed that, despite the demanding work schedule that they had to follow that
week, they were still able to enjoy themselves outside the University and explore the city a little.
However, most found the experience quite strenuous because it was “crammed” in five days, and
some felt that this prevented them from fully experiencing the opportunity of being abroad,
spending time with a group of fellow Occupational Therapy students, and in some ways affected
their learning experience.
One student said that she would have liked the chance to get to know the Swedish students
outside the University, “in their homes, in their environment” and to chat about shared issues of
interest outside the very theme-focused project work.
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Wanting to be ‘good visitors’
Several described their experience of the first day as “very rushed” and “too busy” and questioned
the decision to schedule a lecture to start shortly after they arrived in Lund, after a long journey
and an early start.
Boom! As soon as we arrived we were straight into work, there was no time to really like come down
and relax … it was all very, very rushed on that first day.
Some described feeling “embarrassed” and “frustrated”, being too tired to actually focus on the
contents of the presentation, and many of them feared “falling asleep”, something that could be read by the lecturer and the rest of their hosts as “inconsiderate” or “rude”.
However, many of the students who described the week as being very “busy”, “intense”, “stressful”
and “hard to cope with”, confessed that the pressure of time was, overall, a good thing. In their
words, it was “a challenge, but a good challenge” and “difficult, but a good thing.” One of the
students described how despite being faced with common difficulties and frustrations, “we still
worked together to make sure each other were doing okay with their own projects and things”,
and admits that sharing these challenges turned into a rather bonding experience:
I think actually it almost brought us together because it was quite frustrating and tiring; I think that was an
aspect that actually probably brought us together a bit more.
For some, being able to manage the intensity of this experience increased their self-confidence and
brought them a “sense of personal achievement”:
Although it was a really, really stressful week that went very, very quickly and was very fast paced … I’ve
come back with this sense of achievement, personal achievement, because I’d been quite poorly in the
summer and I didn’t think that I was going to be able to make it.
A common identity
Students’ different impressions of how their work developed had at least one thing in common:
they express how the intensity of their involvement with each other, and the sense that they “were
all OT’s” and “like-minded people”, influenced the success of their small group project work.
One student emphasised how, when the group was struggling to find a way of leading their project,
they spent a long time discussing important issues, and found that they were “struggling together,
struggling with the same things” and trying to figure things out together. Students cited good
relationships, which developed in many cases into friendships, as fundamental to cope with and
build something together in such a short period of time. The pressure of time, on the other hand,
was also seen as an important trigger for closeness and shared dedication, and fostered good
project management and fair assignment of workload. One of the students explained how the
partnership with Lund students seemed to be enhanced both by the opportunity to socialise and
spend time with each other outside the University, and by a strong sense of working together,
collaborating on “more than a superficial level”:
I think just the project as a whole, working together, putting together the power point, deciding who was
going to read it out … that was all working together. And also the fact that we met up with them out of
Uni or Uni time as well, kind of showed that we had collaborated on more than a very superficial level.
Casual, informal moments and exchanges were seen as important to the success of the project, generating both collective and individual enjoyment and enlightenment. Students described how
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relevant it was for them that they had “a bit of work, then a bit of a chat, then a bit of work.” One
of the students described Fika time, the Swedish equivalent of the British “tea time” or “coffee
break”, as a valuable and insightful opportunity for socialising, important for establishing
relationships and influencing students’ personal development.
I learnt that fika time was great, and actually those who didn’t participate in fika … they lost a great
networking opportunity and information finding opportunity… it’s a really, really valuable tool because
people were getting together and discussing things that you might never find out if you didn’t have that
opportunity.
Working with lecturers
Regarding their relationship with lecturers during the visit, students’ experiences and opinions were
divided. The diversity of answers concerning whether students considered that they had worked in
partnership with lecturers varied not only according to the type of project work that they were
developing (and the lecturers assigned to each of the groups), but also in relation to personal ideas
and beliefs about what could have been planned (or could have happened) to bring students and
lecturers closer together inside and outside the classroom during their week in Lund.
Some of the students worked in groups where at least one of the lecturers was very familiar with
the model or tool to be explored during the week. For example, the ‘Value, Meaning and Occupations’ (ValMO) model (Eklund, Erlandsson, and Persson 2003) focused on how occupations
may be analysed according to values and meaning. The model was created by a Lund University
lecturer who was invited to participate in some of the group meetings in which students presented
their work as it progressed, were able to pose questions, and receive specialized guidance. For the
students working on this topic, this was a unique opportunity to work in close contact with an
academic who developed relevant research in their field.
One of the groups reported feeling particularly supported by staff after they submitted, together
with Lund peers, an abstract to a conference in Washington, US, and got their poster application
accepted. Members of this group felt that they worked in close partnership with lecturers, who
backed their work, commented on their poster and provided valuable advice that contributed to its
improvement.
Other students reported that their relationship with specific lecturers was strengthened as a result
of working on their projects during the week in Sweden. One of the Lund students interviewed
described “creating a good contact with a lecturer”, and how “our lecturers were always there
ready to help, and were quite open.” This same student observed:
[In] our group, our two lecturers were Swedish so I didn’t have contact with the English lecturers. That
was just a random chance … so I didn’t really get a chance to get a taste of what the English lecturers
were like or... how they worked.
One of the British students described how it had been “nice to speak to some of the Swedish
lecturers” and how she thought they had become “a little bit closer” with the Southampton
lecturers as well: “we had that sort of friendly sort of relationships with our lecturers, when we
went away.”
Other students found that they would have had felt more as though they were working in
partnership with the lecturers if there had been a chance for them to be more available to chat
about how the exchange was working, particularly in a more informal context or outside the
University:
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We didn’t see them in the evenings, and it felt a bit like a disconnect between us. And I think it would
have been nicer if we would have at least had just one meal out together … We could’ve talked about
how our day was going.
Overall, students felt welcomed to speak to lecturers at any time, and were confident of a
response, as one of the students noted: “Our lecturers were always there if there was anything that
we needed.” Some of the students emphasized how important it had been for them to have the
support and enthusiasm of their lecturers while they were in Lund:
The enthusiasm of the lecturers transferred to the students which then made us more confident and
helped us with our abilities to actually perform the things that we did over there.
At the same time, students recognized the benefits of a certain degree of autonomy and
independent responsibility, “which at times allowed us to work better.” Some groups found that it
had been beneficial to strike a balance between working with and learning from lecturers, and being
able to work on their projects independently:
The Lund lecturer, we had some time with her, but she sort of just let us get on with it. We organised
with her and she was really good at getting us focussed in our first initial “what are we going to do”, but
then we just went and did it. But that was quite nice because there was never that “Oh there are
lecturers in the room and we have to act a certain way or we have to be good”. It was probably a bit
more relaxed without the lecturer.
Students recognised that there was a strong partnership between the lecturers of the University of
Southampton and Lund University. Some students remarked that, even if they did not see how that
partnership worked and developed with their own eyes, they assumed there must have been a
close relationship between the staff members of both countries, even just to make the whole
collaboration possible. As one student put it, “it worked quite well for them as well, so although I
wasn’t actively watching this unfold I think it did happen”. Some students recalled seeing the
lecturers laughing with each other and discussing how some things were done differently in the UK
and in Sweden, which they interpreted as signs of a shared sense of involvement and partnership.
Students also recalled finding it useful when the Lund and Southampton lecturers were able to get
together to discuss the group work the students had been developing and give them feedback
during the week in Lund.
Other kinds of partnerships
Meeting and spending time speaking to members of the public, patients and people using services
was described as one of the most memorable parts of the visit to Lund. Asked if she could tell us
about her experience in Lund, a student commented:
Awesome… it was very, very tiring, quite intense, but to have the opportunity to speak to real people
while we’re out there, to speak to people that actually use the health service and find out what their
views were, it was just phenomenal.
Another student said that, for her, this was the most memorable thing about the visit:
I think spending that hour with the lady in the community and just hearing her story … I think that’s the
thing that sticks in my mind the most … actually seeing her perspective and speaking to her … I think
spending the hour with her was really the best.
Access to people using services depended on the thematic focus of each work project, so only a
few were able to have this opportunity. In the same way, one of the groups’ research project work was largely based on interviews conducted with members of the public, providing the opportunity
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to spend time speaking to Swedish people they met on the street and who agreed to be
interviewed for their project.
Asked whether they had the chance to work in partnership with Swedish service users and/or
members of the public, all the students who had the chance to be in touch with these persons felt
like they had worked, in one way or another, in a looser more informal type of collaboration or
partnership with them. In most of these cases, students spoke of the importance of “listening”, of
“paying attention to people’s needs and opinions”, and of developing meaningful relationships in
their interactions. They were aware of the influence these notions had to the potential of working
in partnership (including in their future practice). As will be further described below, these
encounters provided very relevant opportunities for learning and for personal development.
Cultural diversity, professional identity and a global community
Similarities, differences, and preconceptions
Asked about their motivation to go to Lund, most students stated their wish to travel, to
“experience a different country” and to learn about its culture. Many said that they had been
looking forward to meeting and working with the Swedish Occupational Therapy students, and to
finding out more about “how they do things out there”, “seeing what occupational therapy is like
over there”.
Going to Sweden was, for most participants, an opportunity to review their own ideas of cultural
“difference” and “similarity”, and the experience of the visit produced interesting and nuanced
impressions both on the Swedish and on the British students interviewed. The experience of this
encounter was differently framed by individual students, and was described by many as a tension
between the idea of a shared understanding of Occupational Therapy, and an awareness of the
diversity of socio-cultural contexts to be found “out there.” For many, the visit changed the way
they thought about cultural “differences” and “similarities”, by revealing the complexity inherent to
individual, social, cultural and economic realities, and emphasising the importance of questioning
preconceptions, assumptions and prejudices. In most of the participants’ opinions, physically travelling to Sweden and spending time with Swedish people in Lund proved decisive in this regard.
One of the students described how important it had been for her to see things with her own eyes
and to realise how some of the things she thought she knew about Sweden were simply not true.
As an example, she told us:
Usually you hear how other people in other countries cope, but in terms of accessibility in Lund, I found
out that they are not that far advanced in accessibility for people with disabilities.
Another student explained that, considering Sweden and the UK, “the cultures, where I expected
them to be hugely different, they were quite similar”, and pointed out that, as a result of the visit to
Lund:
I learnt not to go with pre-conceived ideas that the culture was just going to be completely different from
ours, and that it’s actually easier to ask people about what their culture is rather than just second-
guessing.
She went on to reflect on how these insights could be:
really good to take into practice, because we see so many cultures within Britain that, actually, if you are
not sure of what they do then they’d maybe rather you ask.
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The issue of cultural diversity was a recurrent theme in these interviews, and it was interesting to
realise the many different ways in which the visit influenced students’ perspectives on this matter.
A sense of oneself as part of a global community of practice
For some students, going to Lund made them think about Occupational Therapy as a practice that
crosses borders and cultures, and proved that despite “cultural differences” and “language
barriers”, occupational therapists in different parts of the world are united in their professional
values, goals, and views of the needs of the people with whom they work. For one of the students,
one of the most memorable things about the visit to Lund was the realisation that “we didn’t
necessarily have the same first language and hadn’t met each other before, but we were still able to
get along because we had the same sort of attitudes and beliefs because we were studying
Occupational Therapy”. In her view:
There is always going to be a reason … to become an occupational therapist, I believe that you have to
have the right frame of mind, or the right attitudes and beliefs. So it was nice knowing that even though
they’re from a different country, they still had the same fundamental beliefs about helping people and
improving quality of life and independence and things like that.
For many students, going to Lund to meet other occupational therapy students, lecturers and
practitioners had an important influence on their sense of self as future occupational therapists, as well as on their sense of being part of a global professional community. As some students
remarked, meeting other students who were at the same stage of their professional education, but
learning in a different country, and being able to discuss how they saw themselves as occupational
therapists, played a fundamental part in this process.
Speaking about the expectations she had for the visit, one of the students revealed:
I just wanted to meet more people who were doing occupational therapy, to gain a greater understanding
of what their vision of [it] is compared to our own, which definitely happened.
For some students, the project work they developed in partnership with the Swedish students increased their “knowledge of the wider professional network, and how things are done differently
in different countries”. On the other hand, working both with the British and the Swedish students
in Lund and “being part of a big group of OTs increased my identity as an OT, it made me feel a lot
more part of a group”. This student added that “it was just really nice to meet other people
studying OT and find that we’re all wanting to do the same thing and have similar ideas”, and how
important that was for “getting quite a feel for our identity as OT students”.
Meeting other students was described as an important contribution to “coming away with a more
concrete sense of self” – by providing an opportunity for occupational therapists from different
countries to interact and work together, this encounter made the idea of a “global OT community”
more palpable and inclusive for many.
Asked whether the exchange made her feel as though she was part of this community, a student
replied: “I do more now … now that we’ve had some interaction.” She went on to explain how the
encounter changed this feeling:
I think it was that realisation that there are lots of us out there and that you’re right here and you’re part
of it. You’re going to go home, but you’re still going to be part of it.
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Another student agreed that the visit made her “more aware of OTs in other countries”, and that
“physically experiencing that was interesting”, but that “going there” may not be the only way of
claiming membership to this international community. This student stressed the importance of:
being able to use the social media, to be able to be in contact with other OTs around the world. That
makes you understand the bigger picture. So it’s not just going to Lund.
In the opinion of another student, being able to participate in this exchange simply “re-established
that” notion of being part of a global community: “I already felt part of a global OT package so to
say, because on Facebook you have a lot of OT groups and they’re global”. For her, the exchange
visit to Lund “has just reconfirmed that yes, it’s not all about us in Britain. Everyone everywhere is doing really really good work in OT.” Asked about how she thought it would be possible to sustain
that feeling of belonging, she mentioned the importance of keeping an eye on these Facebook pages
“because that’s really helpful”, and she would “maybe feel more confident to join other ones once
qualified.” The same student emphasised that the sense of being part of a global community could
also be improved “by keeping on with the research, doing research and sharing that with the
world”, “because research doesn’t obviously just stay within Britain.”
Realising complexities
As a result of the discussion on socio-cultural diversity, opinions divided on the subject of working
abroad. For some, the experience of the exchange made them feel more like it is possible to work
in another country because, despite cultural differences, the profession’s principles seemed to cross
these boundaries. For others, the increased awareness of social, cultural and economic differences
generated new questions related to material inequality; to the need to consider and carefully
manage fundamental cultural differences; and to the fear of being unable to fully understand and
bond with people using health and care services in another country.
The tension between these dynamics were sometimes found to coexist in the opinions of individual
persons, who confessed they thought they may have sounded as though they were contradicting
themselves within the interview. One of the students began by stating that, arriving in Lund, she
was “surprised at how recognisable OT was”, and how she had expected that “there might be
more differences maybe, in how we view OT, but the broad kind of approach and philosophy
seemed to be the same” – at least in Sweden, she added, because “of course that might not be the
same in other countries.” Asked about whether she thought the visit had prepared students for the
prospect of working abroad, the student explained that going to Lund “definitely made you realise
that, in theory, you could work in another country as an OT, because other countries potentially
look at it the same way as us.” However, when asked about her personal expectations and plans for
working abroad, her reply focused on the drawbacks of speaking a different language, and the
possible difficulty of bonding with patients or people using health services in a different country
because they did not share the same cultural and historical background:
Although it did made me go “Oh! OT is the same in Sweden”, you know, there are similarities in Sweden
as there are here, which potentially might make you go “I could work in another country”… but I also
think that knowledge of culture and the country and language and everything else is really crucial to being
an OT. I think, actually, it was Sweden that made me think this. Because I just thought, you know, it’s so
important to be able to relate to people, … and when you don’t know anything, you know, you don’t
know the history of the country, you don’t know culturally what people do, you just … I think it would
be quite hard to establish like a connectional relationship with clients.
This student concluded by adding “I’m not saying that it is not do-able, but I think I would find it
hard.”
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On the other hand, students were able to problematise the issue of cultural comparison in other
complex ways by reminding themselves that, besides what they saw as examples of socio-cultural
diversity and similarity, there are fundamental differences in how countries work: in how different
healthcare systems are organised, and how the nature and distribution of resources in different
geographical and political contexts takes place. The variety of situations to be found around the
world alerted some students to the importance of considering these factors when imagining a
global occupational therapy community, and made them question any ideas that might arise about
the universal applicability of the profession’s principles and recommendations. As a student
observed:
You can’t just go to one country and say “oh why don’t you do this? We do it over in England.” Other
people might not be able to do it in their own country because of resources, problems of resources, or
other casual problems.
For this student, for example, going to Lund was important because it made her “more aware of
the differences.” The visit showed her that “although we might have the same profession
worldwide, we do see things differently”, and she became more aware that “there’s a language
barrier, and a cultural difference within each country in how they actually perceive being OT or
how they act as OTs.” On the other hand, it made her more aware that – along with issues of
material inequality and access to resources – cultural differences, even if small, can make a great
difference in how healthcare is practised in different places:
I’m aware of the differences in the different countries… it is all about a lot of casual differences plus how
the actual system works, the health system works … And that affects what service people get.
So these are some of the ways in which the visit influenced students’ ways of seeing the world and
placing themselves, as healthcare professionals, within that world. Most agreed that their awareness
of cultural issues, and of the international/global nature of healthcare had altered in ways that may
play an important part in their future careers. This matter is discussed in more detail in the section
below.
Expectations, experiences and achievements
Expectations
The opportunity to conduct in-depth interviews with students allowed us to capture the
complexity of their impressions and opinions, particularly in relation to the expectations they had
before travelling to Lund.
Most students reported that they were unaware of the list of goals that had been set by the
academic staff. One student observed:
I don’t think before [travelling to Lund] I really knew why we were going, I just thought we were going to
do some group projects and it would be a fun exchange or something they wanted to set up for the
future.
For some students, the in-depth interview was seen as a good opportunity to reflect and to realise
what had actually been achieved:
I don’t think it was really made obvious to us what the whole point of it was. But I don’t think that was
necessarily a bad thing.
But I don’t think I necessarily thought about the things until this interview.
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However, some students were of the opinion that it would have been beneficial to have more
preparation beforehand, and that having been given at least “one overarching goal” would have
been important to enlighten some of the students who were “not sure what the point [of the visit]
was” before going to Lund:
I will throw myself into anything, whereas some people will be like “oh I don’t really know what is the
point in this”, so they may not have gone on the trip for those reasons.
Interestingly, even students whose interview revealed how much they were influenced, and who
provided rich accounts of their experience, didn’t seem aware that these transformations had
actually taken place:
Again, I feel quite contradictory about Lund. Because I really did enjoy it a lot, and I feel really privileged
and grateful that we had the chance to go, and I wouldn’t have wanted to not go. But I am not sure how
much it adds to me in terms of improving me as an OT or my practice.
This student suggested precisely that being introduced to some of the “aims and objectives of the
visit beforehand” – maybe in “a session” to take place before the event – would have been helpful
to have: “you know, made us kind of think about them before we went”. Another student
manifested her concern about students’ wellbeing:
I would have liked a little more notice of what to expect before we went … especially for students who
have mental health issues that like to know …
I know you can’t know everything all the time, but would have liked a bit more so that they could have
got it organised within their minds. I think would have been better.
Students’ expectations for the visit, and their opinion on whether the pre-visit preparation was
satisfactory, also varied according to the subjects researched within work projects. For some, a
brief introduction was enough, and left them enough space to “work things out” together during
the week in Sweden. Others thought the complexity of the subjects required more preparation,
and that they would have benefitted from more time to get acquainted with the subject they were going to work on as a group beforehand – especially given the limited amount of time they had to
develop their project together during that week. Asked whether there was anything she would
have changed about the project, one of the students explained:
I would’ve liked to have known a bit more about the housing enabler tool before we went out, because it
was very, very, very tight with time..
We did have a couple of journal articles that we read before we went, but have that opportunity to really
get to grips with the housing enabler tool so we could have made that project more enriched.
Students’ openness to speak about some of the things that they thought could have been done
differently did not, however, impinge upon their excitement, gratefulness and admiration for the
people who made the exchange project possible. All the students we interviewed were eager to
voice how much they had gained from participating in the visit, and many provided vivid examples
of how it had affected or transformed them.
Personal and professional development
Every student interviewee who was in some way involved in the exchange project claimed to have
learnt new things from this experience. Different individuals described, with different emphasis,
how the visit to Lund improved their confidence, confirmed their identity, transformed their views,
raised their awareness of the need for cross-cultural understanding, and/or just generally influenced
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their well-being and sense of self. This was attributed variously to new knowledge, improved skills,
new career possibilities and ideas for future research or specialisation.
Many felt able to explore topics, models and assessment tools that have been created in Sweden
and which are not routinely used in the UK, for example, the ValMO model, the housing enabler
tool, and lifestyle redesign approaches. By being required to actually employ these instruments and
principles, students were able to “learn by doing” and understand the implications and potential of
new approaches. Working with service users and with members of the public made a profound
impression in some of the students, and raised their awareness to issues they might not otherwise
encounter in their education:
It has reconfirmed how the most important people are our patients, and that they really need to be
listened to with respect.
So this housing enabler tool, the fact that it concentrates on just their home, when in fact … the
community was the most important thing for these people who we were talking to
… when we’re making up new tools or when we’re talking to people, we need to find out what’s
meaningful to them, because that is what we’re all about, really.
For some students, working with these new tools allowed them to rethink theoretical concepts and
practical issues in ways they had not considered before. Other felt more keenly aware of the
potential that some of these tools and models have to be applied “not only in Sweden” but at an
international level, contributing to raising the quality of Occupational Therapy practice at a global
scale.
Project work seemed to broaden perspectives and heighten awareness of potential career avenues.
One of the students whose group project focused on lifestyle redesign observed “I don’t think I
would’ve learned about lifestyle redesign if I hadn’t gone to Sweden”, and realised that working in
this area could be an interesting option for her future:
Lifestyle redesign … did kind of make me rethink … differently ... I suppose it sort of made me go “Oh! I
could go down that path.
For some, doing research became, for the first time, a possible future career goal: “I hadn’t even
considered research before and now I have”, a student remarked, affirming that the exchange had
“definitely” altered her hopes and goals. The project work group, which submitted an abstract to a
conference and got it accepted, experienced a sense of achievement that became an important
incentive to dedicate more of their time to doing research work.
Working abroad
The experience played an important part in bringing to the table the possibility of working abroad.
Opinions and impressions divided on this subject – both in terms of what students hoped to
achieve as professionals, and regarding their confidence and views on the implications of working
abroad.
Some of the students stated that the visit had merely confirmed what they already knew they
wanted to do and had planned to do for sure:
I’ve always thought that sometime in my life I would move abroad.
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Other students said that “they were already doing it” since they were from a different country
from the UK or Sweden and they had moved to one of these places to work and study. A small
number had always wanted to work in the UK but felt more open-minded now:
I wouldn’t feel as confident, but I certainly wouldn’t not think about it – whereas before this trip I
certainly wouldn’t have even considered working abroad.
For other students, the visit was energising, encouraged them to travel more, and made them
consider the possibility of working abroad quite seriously.
I’m already thinking “Right, there’s more out there, so what else is there that I’m missing?” Because they
obviously had a really different perspective so I imagine that someone in like Australia or Africa or
somewhere would have another perspective.
During the interview, the student identified a specific example of how the exchange project might
eventually inform and contribute to improving her healthcare practice. She described being more
aware of the sensitive nature of socio-cultural diversity, and the need to think about it in her
everyday future practice:
It made me realise again the whole [thing about] culture differences, and that you really do have to think
about people and their culture differences. So if as an OT if I have someone coming in from somewhere
else [I need] to think about “well, what do they believe?” “What do they think if they’re not necessarily
British or been in England a long time?” Because things are different and cultures are different. So [it
taught me] to think about people and their cultures and not necessarily the person in front of you. And
what you can do to help them, within their norm culture-wise, and adapting how you do things, or
something like that – rather than just being like “you’re just like me so I’m going to treat you just like
me.”
Other students reported how the project work they developed in Lund brought them similar
insights, “widening their views” and making them more aware of the importance of “good
communication” and its influence on mutual respect and understanding in clinical practice, both in
their relationships with other professionals and with future clients.
The development of meaningful relationships was described as an important part of students’
learning, and it was found to have contributed, on the one hand, to successful and productive
partnership working and, on the other hand, to the creation and development of personal and
professional networks, and an improved sense of being part of a “global OT community”. So
despite “language barriers” and “cultural differences”, for many, participating in the exchange
project generated more optimistic expectations and made it clear for them not only that “it is
feasible to be an OT in other countries” but that they can successfully pursue their careers abroad
in places and contexts that they would not have thought about before.
New skills, and a new confidence about “what is possible” meant for one of the students: “I learnt
that I can do it.” This is the longer version of her answer:
Okay, I learnt that I can do it. You can go, and you can be part of a group, and you can go and do things.
It’s very easy doing it in your comfort zone and a place that you know, but going out there is that step
further, that little bit of a push just outside of a comfort zone. But yeah, I learnt that I can do it.
Communicating and language differences
A range of nationalities, ethnicities and first languages existed among interviewees so to avoid
confusion this section refers students as being from Lund or Southampton; the exception being in
direct quotes from students.
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In one student’s opinion, refining her “communication skills” was vital to improving her confidence
in establishing relationships and working in partnership. The issue of communication was a
recurrent one. Many students found that working across languages was a challenging experience,
and students from both countries explained how they managed this situation during their week
together in Lund. Even though most of their conversations took place in English, one of the Lund
students emphasised how attempting to work together in a foreign language proved difficult for
some. This student described how, despite some Lund students’ impressive ability to speak English,
several were not comfortable working in a second language and sometimes struggled to
communicate, even though “they tried their very best.” This student described how some of the
discussions had to take place in Swedish among the Lund students in order for the group work to
progress.
Southampton students praised the Lund students’ English speaking skills, their willingness to work in
partnership combined with their ability “to do it in a second language”, and the fact that “most of
the Swedish people we interviewed spoke in English.” They found that “the Swedish students were
brilliant and very, very accommodating” and noted “none of us spoke Swedish, which was seriously
sad.” Some of the Southampton students mentioned how they realised that sometimes they needed
to adapt the way they spoke to make sure they were understood by the Lund students and how
this had been an important learning experience.
One of the students described how “we had to speak Swedish a little bit” in preparation for the
final presentation. Overcoming the language barrier was a great achievement, and made her more
confident about establishing relationships with people for whom English is not a first language. Some
wish to learn other languages in the future; one revealed how the fact that that the Lund students
were so accommodating made this possibility seem less daunting:
People speaking English so that I feel comfortable, that gives me enough to learn a language as well. They
were very kind when they spoke in English, but they also allowed us to learn from them.
All students interviewed agreed that the requirement to prepare and present their project work on
their last day together in Lund gave them the chance to exercise and improve their public speaking
skills. For some, this meant they had to “get out of our comfort zone”, do something they found
daunting and difficult, and turned out to be a rewarding experience that both improved their
confidence and successfully “enhanced our public speaking skills.” One of the Lund students spoke
about how helpful this opportunity may have been for some of the students, “especially if you’re a
bit scared about doing presentations” and particularly if there is a requirement to do it in a second
language:
I wasn’t the one doing the presentation in our group, but the Swedish [student] who did it in English said
that “it’s scary but I’m so happy that I did it”, and just liked to prove for herself that she could do it. So I
guess for the people who actually did it they were really proud of themselves and will benefit from that.
A sense of identity
Many students explained how the time spent in Lund influenced their sense of self, their identity as
occupational therapists and improved their confidence in multiple ways. For some, this opportunity
was an unexpected source of energy and motivation, improving their mental health and general
wellbeing, and suggesting new personal and professional paths:
I feel more like an OT, I feel that my confidence has increased since returning from Sweden. At the end
of last year, it was quite a stressful year, the second year, it was quite horrifically stressful, and it left me
wondering if I was doing the right thing. But after going to out to Sweden and seeing all the third year
students and how excited they were, and then coming back and submitting abstracts that we didn’t think
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were going to be accepted but were … I think it has just built on everything that I knew I wanted to do,
and has made me more passionate … and a bit more passionate to do research!
Other participants mentioned that the visit to Lund “was a really nice experience for us to do as a
group” going into their third year, and described how it “made us a lot closer in our course” and
“sort of re-ignited our passion for OT.” Others said that being able to manage the fast-paced week
and intense workload, and being able to successfully complete their project by working intensely
together left them with “this sense of achievement, personal achievement.”
Using social media
For some students, learning how to use social media in order to record and share the experience
of the exchange was seen as a really valuable achievement. It was something they would not have
engaged with if it had not been promoted by the organisation of the exchange, who provided both
equipment (iPads) and training for those students who volunteered to do it. One of the students
described how she learned to be “a bit more technology friendly”, and how she had enjoyed using
the iPad to take pictures, learn how to tweet, blog, and essentially be able to keep a diary of their
experiences in Lund. This student also emphasised how she wouldn’t have done “anything like this”
if she had not been given the chance, and how it had been important for her to attend “the
meetings with tech people” that took place before the visit.
For this student, using social media to “tweet or blog about our experiences in Lund” was a way of
“making people aware of what we do as OTs”, and she felt that it would thus “improve the profile
of our course, and of Occupational Therapy.”
Other students who were less active on social media during the visit still praised the initiative, and
one of them commented on how it was:
really impressive that people that don’t normally use social media took it on, and kind of set themselves a
talent … I think that was good, and I can see the value of doing that as part of the project.
At the same time, many students commented on the importance of social media like Facebook to
secure and develop their personal and professional networks after the exchange, and to improve
their knowledge and identity as occupational therapists. Using Facebook to follow and participate in
international discussion groups and communities raised their awareness of a “global OT
community” and made them feel more included in it. It also turned out to be an important tool to
keep in touch with the Lund students after their week together, in the same way that it had been
important to use before they had met for the first time in Lund. Some students described how
“knowing the names” of the students they were going to meet in Lund, and having the chance to
chat to them beforehand via Facebook was a good way of “breaking the ice”:
We were able to ask them what the weather was going to be like, we were able to find out if there was
anything that they would like from England to be brought over as gifts, so we brought over chocolate and
stuff, so that was really nice and it kind of broke the ice a bit before we arrived.
Another student said that social media made it possible “to build up the first relationship and get to
know each other” before they met and started working together in Lund.
Facebook has proved to be an effective way of keeping in touch after the exchange programme as
well. While some students have created a parallel group where they can keep working together on
their poster submission to the conference, others mentioned that simply having “formed a
relationship and made Facebook friends” means that they can easily be in touch with their peers:
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Now you can sort of use that at any time you want, to like go back and speak to them, or bounce ideas
off them, or ask advice, or whatever. So that’s kind of … you’ve formed a connection – in the same as
you could on a clinical placement with your supervisor. You can go back to them, you can email them if
you want to. It’s kind of the same thing. So it’s kind of widened the network really of people that you can
go to.
Social media was also mentioned as a possible way in which the students and staff who stayed in
Southampton may have been able to be more involved. The Southampton cohort’s private
Facebook group was being updated during their week abroad, and a student observed: “if we put
anything up there they would be able to see it.” In her view, however, this would have been a
passive way of letting the other students know what was going on since she admits “I don’t think I personally had much contact with people who didn’t go to Lund, because I was so swollen up in the
focus of Lund, and everything there, and the people that were there.” Other students mentioned
how blogging and tweeting while they were in Lund may have made people in Southampton and
elsewhere aware of their activities that week. One student noticed how some of the staff back in
Southampton had been “quite active on Twitter, and looking at the blogs and stuff”:
A couple of us had been tweeting a lot and writing a few blogging bits, so there was quite a bit of
feedback from them. I know there were a couple from health sciences who were constantly responding
… so that was really nice.
For students, most of their learning was tied precisely with the relationships, friendships and forms
of partnership that they developed before, during, and kept after their week in Lund. The idea that
these relationships are not only meaningful (some of the students speak of “the friends they made
in Lund” – one of them is even coming to visit this summer), but that they can also be productive
and form future collaborations, partnerships, or simply prove useful in providing advice or
information, shows the potential that an exchange project that requires students to work together
as partners can have to influence, improve or transform disciplines and forms of clinical practice –
both on a local and on an international scale.
Reflecting, speculating and imagining: parallel perspectives.
If we consider that an important part of this international partnership project consisted of the
encounter that took place when the Southampton students visited Lund, it may be interesting to
compare some of the ways in which the students who were involved differently in the exchange
project perceived their own position and imagined other students’ experiences. We were able to
interview two of the Lund University students who worked with the Southampton students during
their week in Lund, one of the Southampton students who was unable to join the visit to Lund but
who nevertheless participated in the parallel virtual communication events, and one of the
Southampton students who both participated in the whole-cohort visit to Lund and was able to
return to Sweden shortly after for an individual three-month Erasmus exchange (between January
and April 2015).
Looking at these quite different perspectives allowed us to consider how the exchange visits
seemed to make students more in touch with their own impressions and opinions, and more aware
of how others may have felt about the experiences they went through together, or the experiences
that some of them may have missed out on.
Going and not going to Lund
For different reasons, some of the students who were part of the Southampton cohort were unable
to join the visit to Lund. Since the international exchange project was planned to include not only
the physical encounter between students and staff from both countries, but also other forms of
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communication and collaboration through remote means (Skype/video-conference, email, blogging,
twitter and Facebook), we were interested in finding out whether students felt any sense of
partnership working with the students who did not go to Lund. Replies varied in length and depth,
but most Southampton students who were able to travel to Sweden agreed that it had been difficult
to feel as though they had been working in partnership with peers who remained at home.
Trying to explain why there had been “no grounds to really form a partnership”, some of the
students spoke about the importance of “being there” and how they realised that “it’s difficult to
form a partnership if they haven’t experienced it as well.” These two students expressed their ideas
about the difficulty of sharing and making other students “understand” a complex experience that
they had not been through:
I felt that was quite tricky because it was an experience that, although you try to share it with the people
that didn’t go, there was always that element of “you don’t really understand because you weren’t there.”
I think that … it was very difficult to come back to the lectures about Lund knowing that there were a
few people that didn’t go and it was almost as if … If I was them I would have thought “why do I need to
be here because it’s not something I’ve experienced.”
That was quite hard, I think. We did some work with them when we first came back, and some of them
were really interested … but I think unless you've gone and sort of experienced … I think everybody
who went to Lund bonded a lot; through staying in the same hostel … and we bonded a lot just like
generally being around each other 24/7 … I think it was really lovely. So the people that were out of that
unfortunately missed something that … it was quite hard to sort of explain the experience, especially
when a lot of it is just about being somewhere and sort of picking things up. Yeah, it was quite hard to
explain, and I think as interested as they sounded … it's hard to connect with something you haven't
been involved in.
Some of the students spoke about the awkwardness and difficulty of sharing their thoughts and
experiences with the students who were unable to travel to Lund because they believed that those
students had missed out on something important, and felt a degree of guilt or fear that the other
students might be left feeling “ostracised” or “left out.” One of the students confessed:
I think I felt a bit self-conscious and a bit sorry on the occasions when we did talk about Lund with people
who hadn’t gone, because, I mean, they probably didn’t mind, but I felt like it was a bit … I felt that they
might feel a bit out of it and a bit excluded.
Another student explained this situation by providing an example of a specific aspect she feels she
would have missed out on if she had been unable to join the visit to Lund:
I do feel for the people that weren’t able to go because I think it was a very … it was a really missed
experience.
Some students highlighted the need for better communication, and suggested that some of the
disconnect between the students who did and the ones who did not go to Lund may have been
caused by the failure to involve them in related group activities. They suggested that, since some
students were unable to travel, these events could have taken place in Southampton, remotely and
simultaneously with their project work in Lund.
I don’t think the people I know have really engaged with us and I don’t think we even engaged with them
properly. I think they felt ostracised maybe because they didn’t go and there was no opportunity for them
to listen to talks or anything like that because there were tech problems, so they didn’t have access to
any of that, or they weren’t involved to do any work at university while we were over in Lund. It seems
light years apart, the people who went to Lund and the people who didn’t.
This student also highlighted how there should have been “more information given to” the students who stayed in Southampton and that “their input” should be valued and listened to as well.
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Friendships within the cohort seem to have also influenced the degree to which students were
involved in the activities that took place that week.
One student’s experience of staying at home
A student who was unable to go to Lund explained how, although she felt “a little bit left out of
it all”, felt she was still included in the discussions and in the progress of the work of the group
she was going to be part of if she had travelled to Sweden, and was able “to gain something from
it”:
Hm, I did feel a little bit left out of it all, I think. But it was nice because all of the students that did go
to Lund kept in contact with me. I don’t know if they did with the other students, but I was updated
in what they were doing, and the group that I should’ve been in whilst I was there, I spoke to the
students that went and they told me what they did, and what they learned from it, so I did kind of get
feedback from them. So I was able to gain something from it, I just didn’t participate myself.
In her opinion, the invitation to be interviewed and take part in the present research project has
also played an important part in her feeling more included in the whole exchange project
experience:
When everyone came back and they were talking about this research project I didn’t really feel I
could get involved because I hadn’t been [to Lund] and I didn’t really know what had happened, but
it’s nice to be involved in that I get to be a part of this, and I get to give my opinions of staying at
home, so I feel involved in that way.
It was interesting to observe how so many of the feelings that this student experienced matched
the impressions and opinions voiced by many of her peers:
I think it’s opened my eyes a bit more and I think it’s encouraging me to not be quite so narrow in
what’s going on here and now, and maybe to look elsewhere for ideas or inspiration, or even support
… Maybe there’s, you know, OTs working in other countries that really specialize in an area maybe
that I might see in the future so, I don’t know, it has just kind of, yeah, broadened my horizons. I
think.
She also spoke about how participating in the exchange project, even if remotely, enhanced for
her the notion of being part of a “global OT community” and improved her sense of self as an
OT:
I think it’s good to make contact with OTs in the rest of the world. Not just for finding out what they
do and then bring their practice over, but it’s just to know that … I don’t know, that we’re all
working towards the same goal, I guess. Even though we’ve all trained in different places, and we’re
working in different cultures and countries, it’s just … I don’t know, it makes me feel even more
excited to be an OT, I guess. Because there’s hundreds of other OTs out there and, yeah, it makes
me feel part of a bigger community, other than just this community.
At the same time, there was an interesting contrast between the energy and renewed
motivation embedded in the statements given by the students who travelled to Lund, and the
slightly more shy and restrained resolutions expressed by the student who stayed at home.
For me still I’m … I don’t know, I guess I want to know what’s going on in the wider world. But, I
don’t know, I guess I’m just happy with what’s happening here and around me. Um, I’d be interested
in terms of reading about it, but I’m not sure … I don’t really know.
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As described earlier, some students who were initially less open to travelling and working abroad,
for example, revealed how the physical visit had a powerful transformative effect on their
professional and personal hopes and ambitions, suggesting that going to Lund may have been an
important opportunity for making them more welcoming of change and less reticent about
widening their future plans and ideas. At the same time, the interview with the student who stayed
at home highlights how individual students may have benefitted in very diverse and personal ways
from the idea or possibility of going, and by their friends’ experiences of the visit. Despite being
“quite happy to continue working in this country” she had been affected:
But now, after this project, and seeing what all the other students have brought back … I think it will help
us as future qualified OT’s to change practice by maybe looking not just in other teams that are in the
UK, but teams outside of the UK, maybe they’re doing something better, that we could be doing here as
well. So yeah, I think it’s a really good idea, and it was a really good opportunity.
Having had the chance to interview one of the Southampton students who did not go to Lund
provided an important opportunity to compare different perspectives and emphasise how, in future
partnerships, much can be gained from attempting to understand alternative ways of involving
students in international projects. At the same time, this interview proved the importance of
actually listening to students who are prevented from travelling but who, at the same time, feel like
they are “still a part of it.”
While other students who did not go to Lund may not share these feelings, it is still a valuable
contribution to understand the potential for forms of involvement, and the extent to which the
Southampton cohort as a whole was affected by this international exchange project.
Enduring connections
For most students involved in the exchange visit, the issue of length of stay and involvement was an
important one. However, Southampton and Lund students’ views and suggestions to improve the
international partnership experience were somewhat different in their nature and intensity.
Most Southampton students mentioned that it would have been good to have stayed a week longer
to be able to complete their group work at a different pace and, at the same time, to have more
time to spend exploring the country and getting to know the Lund students better. Some students
felt that they would have gained a lot more from the experience if they had been less tired and
under pressure of time. The Lund University students, on the other hand, suggested that in order
for the exchange project to have a real impact on their lives, their connection with the
Southampton students should have extended over a much longer time-frame, in ways that could be
virtual only, but which would nevertheless enhance their connection, sharing of mutual interests
and concerns.
Expressing thoughts on whether this experience would have any influence on future hopes and
goals, one of the Lund students explained that “it was just a short timeframe” and how “if it’s one
week out of a three year education there’s not much to affect … your future.” Going on to explain
how the project generated a sense of being part of a wider community, the student felt this could
have been improved by organising and establishing a more enduring form of contact and
collaboration, starting on their first year:
It’s a bit more of a global community than I think I would imagine actually… but, as I said, it was such a
short time period …, I think if there was … a little bit more contact, maybe it wasn’t just one week just
being together and then never seeing each other again … Maybe if it started off and in term one, and then
you might have contact maybe over three terms out of your six terms, just more contact, then it would
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seem like you were a part of a global net thing. But just one week, one week out the blue? It’s kind of
hard to create something sustainable, you know, it just gives you a taste of something.
The other Lund student that we interviewed expressed a very similar idea. She found that the
opportunity to actually physically meet the Southampton students was crucial for her own personal
development, and was “very happy that it wasn’t only a Skype thing, or email, or something like
that.” This student explained that the briefness of the exchange event may have caused it to lose
some of its potential impact and richness. Asked if she could think about any other forms of
international collaboration and partnership that would not require people to travel, she suggested:
I guess you could do a web seminar, but I think then it shouldn’t be just a one-time thing. It should be
something you maybe did at the beginning of your degree when you start at the first year, and then
maybe again at in the second so you see each other grow somehow. Otherwise I think, to me, it would
lose interest. It would just feel like another thing that I have to do.
At the same time, both Lund and Southampton students admitted that they found their own
strategies to prevent relationships from being lost after their week together in Lund – using social
media like Facebook, exchanging phone numbers and emails were some of the ways in which they
attempted to cement a connection between the two countries. We were told how at least some of
these relationships were successfully maintained, leading to the development of work projects,
friendships, and wider networks of support.
13 weeks in Lund: a “life-changing experience”
After the one-week whole-cohort visit to Lund, there was a chance for one of the University of
Southampton students to return to Sweden to take part in an individual three-month Erasmus
exchange programme at Lund University.
In an enthusiastic interview with one of the student co-researchers, the student spoke about what
she called “a life-changing experience”, and highlighted how the initial exchange visit to Lund played
a fundamental part in her decision to apply for the longer exchange programme, triggering an
important “chain of events”:
Now that I’m thinking about it, the chain of events that it’s caused is actually quite life changing, I think.
It’s only when you sit down and think about it … what chain of events that processed for me.
Asked particularly about her experience of the whole-cohort visit to Lund, this student described in
great detail how much the experience of “being somewhere different” and “looking at stuff in a
different way” had influenced her. She emphasises how, although she “really enjoyed the project
work”, that was not the main thing that stuck in her mind. For this student, it was more “generally
the experience of being there, and just seeing how people live in a different country, and their
attitudes and things” that ended up having a “really positive effect” on her:
At the time I think I was getting a bit like stuck in a rut, in Southampton, just slogging away at university,
and things like that. So to get a completely different look at a different way of life, a different lifestyle … it
was really refreshing. And actually I came away from it … just reviewing how I was as a person … so I
ended up doing more exercise and I ended up just being a little bit more positive. And I think it was just
the shake-up of being somewhere different and looking at stuff in a different way.
The student describes how much she hesitated before submitting her application to take part in the
longer exchange programme, explaining that she was almost too nervous and fearful to bring
herself to actually do it:
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I was so nervous about doing it and I literally had to force [myself] … we had to write a personal
statement, and I had to force myself to give it in because I knew that I would be kicking myself if I didn't
go for the opportunity. But it was such a scary prospect that I almost didn't want it to happen.
Later in the interview she explains why she had been so worried about the possibility of actually
getting the chance to go to live and study in Sweden for three months:
I was really nervous about going because I was … socially I was quite worried that I was going to be …
that I wasn't going to make friends, and that the people weren't going to like me, and things like that. And
then I got there and instantly made friends; they had a really good sort of international student welcome,
so you met a lot of people, and I've made really great friendships.
She goes on to describe how having submitted her application to take part in the individual three-
month exchange project “was honestly the best decision I could have made”, how “seeing as it
happened, I was really excited, really happy as well as anxious”, and how it has made her “feel really
positive, really confident.”
This student noticed how living and studying in Lund for three months had a fundamental
transformative effect on her “as a person”, as well as on her political views and on her awareness
to relevant contemporary social and cultural issues. The student reported how this experience
“really refreshed me as a person, and made me think differently, sort of personally.” Living in Lund
and seeing how things work in Sweden made her “more political”, “more leftist”, “more of a feminist.”
I love talking about this. I actually wrote down sort of things that I’d notice about their culture and things
like that … They’re much more equal [in Sweden], so I think I’ve become more political, and … more of
a feminist. I’ve become more leftist, I’ve become more political. I’ve started to think a lot more about
how we treat each other in England.
For this student, thinking about the way people “treat each other” in both countries was a key to
become more aware of how different power structures and governmental systems operate and
how they actually influence and shape people’s lives. Although she admitted “I might be looking at it
through rose tinted glasses”, this student mentioned the issue of education to provide an example
of how “Sweden have got it right in a lot of ways”:
They look after each other. I might be looking at it through rose-tinted glasses, but I can see that that
education is free; it is giving people opportunities that a lot of people in England don't have, because of
our sort of government system. And it has just made me more passionate about that, and about how
people should be living.
Providing a detailed description of one of the placements she did in Lund, this student mentioned
how going out and “working with a big immigration community” was “really influential” to her.
Besides giving her “insight” and “more confidence to work with people from different cultures”,
seeing how in Sweden “they had different projects to sort of bring communities together” made
her wonder about bringing some of the approaches she observed back to the UK as well, and begin
to think “about what we can do with our societies that can be quite marginalised.” She emphasised
that she had “never really had that experience on placement in the UK” and that it “made me think
really differently.”
Living and studying in Sweden for three months had a profound influence in her way of thinking
about work – not only her own academic work, but also the different dynamics that operate in
workplaces, from the way employees are treated, to the way colleagues relate to each other, and
the way work load and work hours are managed. She found that people were “culturally, much
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more laid-back” and how “that has made me more relaxed … not complacent, but just more
relaxed with my studies.”
In England … we get very stressed out. In Sweden people are much more relaxed; their working practice
generally really struck a chord with me … They actually give each other time. They take time, I think like
once or twice in the day, to sit down with each other, to communicate with each other.
Besides improving this student’s wellbeing, seeing how work takes place in the settings where she
was on placement, observing “their working culture” was an important learning experience:
I'm sure it's much more complex, but I really picked up stuff about their working culture. I picked up so
much stuff that really makes me question our practices in England.
The chance to be “out there for three months” played an important part in this student’s sense of
self and identity as an occupational therapist, and has made her become “a lot more independent”.
These are some of the main reasons why, in a review of her experience, she encourages “anybody
to get involved in anything they can, if it’s involving going abroad”:
I just think you learn so much about yourself, about being an OT … you just get a lot more independent
and it’s that challenge isn’t it? It’s pushing yourself to the challenge. And it’s nerve wracking but you feel
amazing as you’re doing it, once you’ve achieved it.
The experience described by this student exemplifies the relevance that longer-term exchange
experiences may have on individual students’ lives, influencing not only their “learning experience”
but actually leaving enduring impressions, transforming personal beliefs, producing new political
attitudes.
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Conclusions and implications
Our brief was to increase understanding of the pedagogic approaches that foster partnership
working, to provide evidence of their impact on student learning, and to offer implications for
teaching and learning practice beyond health disciplines. Our own understanding has been
deepened both by the students’ accounts, and by working together as a research team. We think
there is much more to say about the latter that falls outside the scope of this report. Students’
detailed accounts and the meanings we construed provide forms of evidence that their learning was
affected, at times deeply, reflected equally in anonymous survey responses. This final section
therefore concentrates on the broader implications of our findings, as we seek to intertwine
findings with six pedagogic approaches (or sets of principles) already well established in educational
theory and research.
Fostering partnership working through pedagogic approaches: implications for
teaching and learning
1. Working on real projects and shared concerns
Working on ‘real’ projects – by which we mean, those involving pre-existing challenges or goals,
that involve others, require the intellectual exploration of ideas in practical ways, and have some
hope for outcome or conclusion – served to focus students’ attention on shared professional
concerns. Projects seem to have united them – rather than focusing attention self-consciously
and/or self-interestedly on group roles or performances – as agentic individuals, able to stand back
and reflect on their own knowledge and understanding in mature and critical ways. Language
differences, paradoxically, appear to have deepened this sense being individuals working in unity, at
least among our interviewees. Differences in language made explicit, and served to reveal, the ‘hard
work’ going into ‘group work’.
Projects were described as involving and motivating, enabling (some) students to connect social
factors and health outcomes, and to see the evidence of different political and economic decisions on living arrangements and access to healthcare. Time constraints meant inhibitions or social
awkwardness needed to be overcome in order to progress the task. The small groups’ need to
draw on ideas and theories in order to explore practical challenges meant students made
connections and drew conclusions rather than waiting for answers. Projects seem to have become
catalysts for deep thinking and rapid immersion in topics, connecting with values and a sense of
professional identity, requiring high levels of engagement beyond the student group (with others
such as patients or with researchers and academics).
The rich literature that explores work-based learning, learning by experience and learning by doing
is familiar to more vocational disciplines yet can be seen to have relevance to any mutually derived
project work. Beckett (2009, p. 7) is interested in the interplay between social and individual
agency, and draws on Wittgensteinian concepts of intelligent action to assert “it is in the doing that
the understanding is apparent.” In similar vein, Billett (2008, p. 39) talks of “integrating” personal
epistemologies with practical experiences, in the development of agentic professionals.
We can rethink much of the work of higher education in this way; archival research, fieldwork,
shows, exhibitions, even short courses or modules, have characteristics of ‘real’ projects. ‘Real
time’ necessarily means such plans are less amenable to control (or assessment and so on), and
many of those listed are students’ own projects, meaning unique opportunities are afforded to learn
about ‘things’ – such as uncertainty and complexity – and to simultaneously use feedback from
37
peers and from events to revisit and appraise private knowledge and sense of self (Giddens 1991).
Making explicit the dynamic between these parallel ways of learning and the ways in which
individual agency (and goals, desires, intentions) influence and become part of practical, shared
decisions and actions, enables a more reflexive understanding of oneself as part of a social world.
2. Informal learning
Following the idea of real projects with meaning to and control by students, is the important
message throughout findings; that learning together in informal ways was central to students’
motivation and enjoyment of learning. Not only did they value time together but some would have
brought their lecturers into this freer space. Designated ‘social’ time (fika) enabled new insights and
connections through which relationships were developed.
Not being assessed meant experimentation was actively embraced, leading to high levels of intrinsic
and infectious motivation. Students were conscious of the trust placed in them, expressing this as a
wish to be ‘good visitors’ and to show the profession and Southampton in a good light. This may
also have contributed to what staff described as ‘gratitude’ when seeking more critical evaluations,
but may also have been a sense of mutual investment; if evaluation is what consumers do, why
would students criticise something for which they were jointly responsible, and could influence as it
progressed?
The collaborative enterprise is still relatively new and changes will take place. However, we feel
strongly that the unregulated time, naturally occurring relationships, trust and freedom experienced
and described by so many interviewees is vital to a sense of being in partnership. Each contributed
significantly to deep learning, and to a ready engagement with pluralistic thinking described by Perry
(1968) and so valued by Nussbaum (2007). We can surmise that greater regulation – for example,
assessment of outcomes or contributions – would have introduced comparisons, competition and
an instrumental approach, fundamentally altering group working and relationships among finalists.
Instead, experimentation and things going wrong become valuable learning.
We urge educators to create opportunities, with confidence, for the “deep hanging out” described by Geertz (1998) and to resist the temptation to subordinate, co-opt or in other ways to
appropriate powerful informal learning in the interests of instrumental goals even if there is
pressure to do so from students themselves or elsewhere (Usher 2010).
3. High expectations, high support
Being expected to make contact with peers in another country, to manage travel and produce
academic work together to tight deadlines, seems to have been motivating because it was
stretching. Access to experts – academic, clinical and through lived experiences of illness or
disability – meant practical tasks were informed by more theoretically informed and intellectually
stimulating ideas. Small groups were left to work independently and were not ‘supervised’ by these
experts, though we can surmise that their presence and influence created a high expectation of and
by students. Forms of support were seen to come from peers as well as academics, so outcomes of
project work were multiply sourced, rather than part of a binary, student-academic relationship.
The combination of high expectations and high support introduced reciprocity and collegiality into
students’ learning, as they depended on one another, on academics, and particularly on their hosts
to achieve good outcomes.
38
Participants reported building relationships with peers from both universities, and spoke of the
ways in which they worked productively together. Those still in contact spoke of being involved in
ongoing projects, notably taking a poster to an Occupational Therapy conference. This ambitious
plan – also a ‘real’ project – is characterised by high mutual expectations, actively supported but
most definitely not led by an academic. In addition, however, it involves personal relationships
formed in the light of a longer-term goal. This kind of student/peer partnership offers a useful
reminder that such ambitious plans might usefully be propagated, generated and made more
inclusive through education programmes more generally. Kift (2010) asserts that a combination of
high challenge and high support needs to be embedded early in the first year of higher education, if
students are to become independent and lifelong learners. She reminds us, however, that support is
what students experience it to be, not what is intended or judged to be by others. Discovering this
from students through skilled evaluation and research is important if the high expectations are to
be realised.
4. Communities of practice and circles of partnership
Relationships begun through social media introduced students to new ways of being part of national
and international networks. The partnership between the two universities was conceived as an
inclusive one, made possible by technological forms of communication. It provided a reason to learn
to blog, to create a photomontage, to form new Facebook groups and to share creative outputs via
these networks and others, such as Instagram, Pinterest and Twitter. The training in both style and
integrity in online forums, as well as more practical help from student iChamps was needed and
appreciated, as was the involvement of Faculty staff not connected with the project but who took
an interest and shared blogs, tweets and storifys. Such activities have potential to be much more
effective in reaching out, and in actively promoting, inclusivity by supporting communications with
and by students and academics not involved with visits.
However we have become interested in how what we term shared concerns – for a group, an
individual, a region or a practice – can be promoted through membership of communities. The
concept of shared concerns (in healthcare) emerged in previous research with work-based learners
(Wintrup et al. 2013) as they described over-arching health goals or values that transcended different agencies’ priorities and as such were helpful reference points.
Wenger’s (2000) notion of a community of practice, defined as “groups of people informally bound
together by shared experiences and a passion for a joint enterprise” (Wenger 2000, p.139) offers
ways to develop this notion and to value varying degrees and changing forms of involvement over
time according to students’ other demands and responsibilities. Sharing forms of reportage and
orchestrating wider communications, for example, might be a responsibility of those who remain at
home.
Networks offer ways to incorporate many different individuals and groups in a loose and evolving
dynamic, opening the way for forms of partnership that change over time and according to task.
Our contribution to this endeavour is explicated in a ‘circles of partnership’ exercise, an adaptation
of Wintrup et al. (2013, p. 214) as we suggest how students, academics, professional and
technological staff, managers and others with an investment in creating communities of practice in a
discipline, might surface issues, ideas and opportunities, and negotiate in practical ways the shared
concerns addressed and promoted through international exchange programmes. It is hoped that
other disciplines might find the exercise useful in discovering/making explicit their shared concerns,
and in working out how an exchange might further the interests of their wider communities of
practice.
40
5. Embedding principles of care, hospitality and reciprocity in partnerships
Mann (2008) identified care and hospitality as core principles in higher education, fundamental to
the maintenance and strengthening of the bonds between students, lecturers, and
professional/managerial colleagues. Central to both is the notion of reciprocity, evidenced in
students’ words and impressions throughout the research. While more instrumental goals of
wanting to ‘visit’ often provided an impetus early on, we can see the emergence of care and
hospitality in more reflective descriptions of events and in discussions of relationships.
These principles also serve to connect the institutional partnership with the students’ learning
about global health issues, as McEwan and Goodman (2010, p. 103) remind us that an ethics of care
requires thinking through our responsibilities towards “unseen others – both unseen neighbours
and distant others – and to cultivate a renewed sense of interconnectedness.”
Exchanges that focus more explicitly on principles of reciprocity, care and hospitality, as well as on
visiting and exploring, open up interesting questions and research possibilities for cohort peers and staff who remain ‘at home’. In doing so, they bring into the broader internationalisation project the
potential of understanding ourselves as citizens of an international community as we inhabit familiar
places; not only the University buildings but the streets and neighbourhoods of Southampton and
Lund. We have become interested in how reciprocal, mutually energising projects, visits and
connections within the same country, even the same town or city, might be explored through the
lens of partnership and global health citizenship.
Adequate, facilitative technology needs to be part of care and hospitality, if lectures and events are
to be streamed successfully, in accessible and inclusive ways across years and disciplines. The right
equipment and training cannot only be available prior to an exchange visit, but needs to develop
capability in all involved as part of the curriculum. Developing skill and confidence in technology and
social media is a long-term project for most and as such, might usefully be introduced to first years
– using visits and exchanges as a reason to become involved and to begin relationships with peers
across the world. Without an institutional and strategic commitment to care and hospitality, these
operational initiatives are at risk. Ground-up initiatives inform institutional management of the
opportunities for reputational enhancement while strategic/organisational support and direction
enable individuals to be innovative.
6. Students as producers of high quality healthcare
Finally, the impact on students’ learning of coming to see themselves as co-creators, co-researchers
and producers, as one of a community of practice, is very exciting. Constructions of students as
anything other than producers of education are rejected by Neary (2013), who describes a cross-
institutional approach to research education as “a search for the ‘essence’ or ‘spirit’ of science”
(Neary 2013, p.588). This unifying strategy has similarities to the way students described their
transnational discovery of a kind of “global occupational therapy”; co-created, emergent values and
practices they recognised, actualised and felt ownership of, coming to embody the ‘spirit’ of their
profession.
Final year students who participated in this research are largely now graduates, in every sense ‘producing’ health and care, more immediately and directly than their lecturers and researchers.
However in Neary’s (2013) sense, producing is a political commitment to society and to change
that goes beyond conforming to the norms or expectations of others. The renewed vigour
described by students, the articulation of ways of using intellectual means to explore complicated
41
practical social problems, and the deeper, more politically informed understanding produced by
seeing alternative ways of organising and resourcing health services, bodes well for students as
individual and collective agents of change and for national and global health services more generally.
On working together
This research would not have been possible had anyone involved – the students who volunteered
as participants or as researchers, their lecturers, or the research leads – been content with notions
of ‘satisfaction’ as a measure of the worth of the international education collaboration. Almost
everyone who took part was more than satisfied, as early feedback showed. Indeed students
expressed delight and gratitude. Those who did not take part seem to have remained silent; how
do you ask what was it like not going somewhere? It is to the credit of both Southampton and Lund
academics that they wanted to question this appreciative, yet selective, response and to go further:
to discover what was not working well; what, if anything, was likely to be of longer-lasting
educational value; to hear dissenting voices; and to consider the experiences of those who were
unable to be involved in the ‘visit’ to Lund. By not being satisfied with satisfaction, new learning was made possible.
We suggest the concept of partnership challenges established structures of power and influence,
and raises new questions. Across and within disciplines, whether in global or local communities of
practice, or in distant networks of shared interest, ‘partnership’ offers a useful reframing of not only
student/academic relationships, but of student relationships with practitioners, patients and
mentors. The ‘circles of partnership’ exercise offers ways for all students, and others, to contribute
and to develop roles in such international projects, whether (for example) as social media
reporters, as knowledgeable hosts, or as local researchers, in face-to-face or distant and virtual
ways. Beginning such projects much earlier, indeed on day one of university, would enable
relationships to be developed and interests shared between students, as suggested by interviewees,
if subsequent visits are to be part of an international education, not the sole focus of it.
However, if it is not to become yet another rhetorical device, partnership relies on a critical and
questioning stance and a pluralist approach to learning that needs to be recognisable and, most
importantly, lived and experienced by students, across the curriculum. Taken to its conclusion, such
a conceptualisation of the student/academic relationship has implications for the values and
professional development of all who work in higher education.
42
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Acknowledgements
We are grateful to the Higher Education Academy for funding this work under the ‘Pedagogies of
Partnership programme.
We regret that it has not been possible to do justice to all the many generous contributions made
by students and colleagues over the past year within the body of the report, or to recognise the
support offered by those who took such an active interest in our research and encouraged us in so
many ways.
We therefore wish specifically to thank:
All the Occupational Therapy students in Southampton and Lund who took part in interviews, who
completed the survey, who considered and discussed the project with us, and who in any other
way, supported peers, passed on information and encouraged us in our approach. We valued your inspiration, interest and friendliness immensely.
All the academics in Southampton and Lund who took part in interviews, offered and corrected
factual information and became part of our reference group, in particular Maggie Bracher, Ragnhild
Cederlund, Pia Hovbrandt, Corinne Hutt-Greenyer, Gary Kinchin, Sarah McGinley, Lance Bryant
and Bernadette Waters. In particular we would like to thank Teresa Job, Programme Lead for
Occupational Therapy 2008-15 and lead for the collaboration in Southampton, who gave us carte
blanche to research as we needed, responding swiftly and openly to our most awkward and delving
questions.
Kelly Wakefield, who co-authored our original proposal to the HEA.
Alan Borthwick and members of Southampton’s Faculty of Health Sciences’ ethics committee, for
processing the three stages of our proposal and engaging wholeheartedly with the introduction of
students as co-researchers.
Pia Hovbrandt, Ragnhild Cederlund and Lund University’s ethics committee for taking the proposal
to ethics in Lund for the latter stages, also for engaging so supportively with students as co-
researchers.
Fiona Harvey, Education Developer, Institute of Innovation and Learning Development, and Katie
Spires, Student Nurse and Health Sciences’ Digital Champion, who continue to support
Southampton’s students using social media.
Finally we would like to thank all our student co-researchers and co-authors who gave precious
time during their intensive final year of study, at whatever point they were most involved. We look
forward to disseminating findings with you and to your future research.
47
Appendix 1: Ethical issues and approval processes
Ethical issues and approval processes
The evaluation adhered to the British Educational Research Association Revised Ethical Guidelines
for Educational Research (BERA 2011). The following issues are highlighted here:
students’ involvement in the research needed to be completely independent of their educational experience or achievement. No educator or academic associated with students’ education was
able to know who had participated (including the project lead). To ensure this, the dedicated
researcher managed all participants’ identifying information and data, ensuring confidential
treatment of material and full anonymisation of data. Student co-researchers worked closely
with the research assistant to this end;
informed consent was obtained from all participants;
participants were free to withdraw consent and data at any time;
information obtained during the study was treated as confidential with names or identifying
features removed in the analysis and prior to the reporting process to preserve anonymity;
because of the potentially vulnerable nature of continuing student participants, only the research assistant (who has no involvement in the administration or teaching of the
programme) knew the names of all volunteers, and keys to coded data. She oversaw the
interviews and carried out data analysis in consultation with the research team. The project lead
offered methodological supervision, theoretical input and advice to the research assistant on
any issues arising, not covered by the normal procedures for student support/complaint/health
and safety/ethical considerations;
student co-researchers adhered fully to all ethical and procedural requirements of the study,
including reporting any unforeseen or unanticipated issues to the research assistant. As third
years only months from graduating as health professionals, a high level of professionalism was
required and anticipated;
student co-researchers were employed as ‘temporary workers’ through the university temp bank meaning they were paid on an ad hoc basis for their work as part of the research team,
properly managed and supervised and held accountable for their work.
Data protection and anonymity
The names of students who registered an interest in taking part in this study are stored in a locked
filing cabinet. This information, along with raw data, will be stored for 15 years from collection, as
required by the University. It is used only to contact students at various times regarding their
participation in the study, for example to invite them to interview or to provide updates or
feedback on the research.
Documents, interview transcripts and backups of interview data files are stored securely. Digital
copies are stored in a password-protected file. Once a student consented to the use of their data
or completed an interview, they were allocated an individual code, which was assigned to their
data, digital interview file and their interview transcript. The key to the codes is accessible only to
the research assistant during the research period and thereafter to the project lead. Within
interview transcripts, names were omitted and changed in any reporting, to preserve anonymity.
48
Appendix 2: Example of interview schedule
Interview questions, set 1: Southampton students who visited Lund.
1. Introduction
Refer to text describing the project, reiterate consent/withdrawal of consent procedures and
what will happen to the interview data.
Introduce yourself
Explain the project
Explain the conditions of the interview, how
long, types of questions, recording arrangements.
Explain confidentiality considerations: remind
them of conditions and arrangements
a. Assign participant number and date of interview
b. The Participant
Gather demographic data
Optional
c. Main questions
Could you tell me about your experience of the
visit to Lund?
Begin audio recording
Optional/additional questions:
What was it like?
How did you find the experience?
In relation to your project work, what
was the project title? What did you do?
Was it useful / interesting?
What was most memorable about the visit? Is there anything you would have
done differently?
Was there anything you didn’t enjoy?
Is there anything else you would like to add about the visit itself?
Optional prompts to elicit rich description:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
49
Is there anything you would like to add?
Are there any other thoughts or experiences you would like to add?
- offer space for reflection/additional
thoughts and comments before next set of
questions.
2. The purpose of the visit: the stated goals and whether these were achieved in the interviewee’s
view
The collaboration and visit to Lund was intended
to achieve a number of goals. I will go through
these and ask you your opinion on them.
The visit was intended to:
Develop meaningful international collaborations between staff and students
Allow students to develop a greater awareness
of how academics can learn from each other,
exchange best practice and evidence based
practice to inform the curriculum.
Through the visit, students will develop a greater awareness of these practices and be better
prepared for the international work market /
consider working abroad / feel more confident
about the possibility of working abroad.
Students will work in partnership, benefitting
from the opportunity to work intensively
together with the Lund students on educationally
challenging and inspiring projects.
Students will use social media to learn, communicate and work together.
After a week-long participatory programme
including education, practice and research based
workshops, students will report and disseminate
outcomes through article and conference
presentations
The visit will enhance students’ learning experience and exposure to international
perspectives and comparisons
Can you think of any other goals – these may be
personal to you or your group – that are not
covered in this list?
Give time to go through each question, judge speed / move on as appropriate.
Range of prompts may include:
Tell me more about that...
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or
experiences you would like to add?
Offer space for reflection / additional
thoughts and comments before next set
of questions.
3. New learning
Did you learn new things? If so, what did you learn?
More in depth questions, as judged to be
appropriate:
50
If so, do you think this will affect your
practice?
Did you learn anything outside the planned curriculum?
Prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or experiences you would like to share?
Offer space for reflection / thoughts or comments before next set of questions.
4. Sense of self as an occupational therapist
Has your sense of yourself as an occupational therapist changed in any way?
If so, in what ways?
Has anything changed for you personally, as a
result?
Has anything changed for you as an occupational
therapist, as a result?
Optional supplementary questions:
After the experience, how do you view yourself? Has anything been reinforced?
Has anything changed?
Were there any other things you
noticed?
Prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
51
Is there anything you would like to add?
Are there any other thoughts or experiences you would like to add?
Offer space for reflection, thoughts, and
comments before next set of questions.
5. Global health community
Do you feel as though you are part of a global
health community?
Optional supplementary questions:
What would enhance or sustain this?
How did the exchange specifically
influence that? For example,
relationships, people, knowledge, self- awareness?
In what ways?
Optional prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or experiences you would like to add?
Offer space for reflection, thoughts, and comments before next set of questions.
6. Your professional / personal goals
Do you think this experience will influence your
(professional / personal) future?
In what ways?
Has it altered your hopes or goals?
Reminder:
It might be useful to differentiate between
feeling able / more confident to work
abroad and / or opening you up to the
possibility of working abroad.
Optional prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
52
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or
experiences you would like to add?
Offer space for reflection, thoughts, and
comments before next set of questions.
7. Partnership working
Occupational therapists aspire to work in
partnership with others. In what ways has this
experience influenced / enhanced your skills in
partnership working?
Can you give an example?
Do you feel you were working as a partner with:
students from Lund/each other /lecturers /
patients or service users/ others /OT students
who did not go to Lund /staff who did not go to
Lund?
Did you see any other kinds of partnerships taking place, e.g. between lecturers?
More in-depth questions as appropriate:
How do you look back on the idea of
partnership – specifically with other
students?
How do you look back on the idea of partnership – specifically with patients
and people who use services?
How do look back on the idea of
partnership – specifically with lecturers
and mentors?
Optional prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or
experiences you would like to add?
53
Offer space for reflection, thoughts, and
questions before next set of questions.
a. On reflection:
Are there any other examples in your education that promote or enable partnership working?
Can you give an example/s?
How do these compare with the Lund exchange experience?
Has the experience changed your views or ideas
about partnership working with patients or
people who use services?
Optional questions / prompts:
That’s interesting, can you say more?
Can you give an example?
Can you give an example of when or
how that took place?
How are you left feeling / thinking about that?
How often did that happen?
How strongly did you feel about that?
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
Is there anything you would like to add?
Are there any other thoughts or
experiences you would like to add?
Offer space for reflection before next set of questions.
8. Expectations / on reflection
Thank you very much for your help. I have three
very short questions to finish with.
Finally, did you know what to expect from the exchange?
Were your expectations met?
Anything else you would like to add or any final
impressions?
Optional prompts:
Tell me more about that?
How did that work?
Was that ever problematic?
In what ways?
Can you explain?
Can you specify / give an example?
Can you describe that?
What happened next?
What was the outcome?
How were you left feeling?
Was that a good thing?
Have we left anything out?
54
Is there anything you would like to add?
Are there any other thoughts or experiences you would like to add?
Offer space for reflection, thoughts, and
comments before next set of questions.
9. Close, thank you, reiterate wish to withdraw
consent or data from study, arrange for book
voucher to be emailed.
Stop audio recording.
55
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